Focused Pain Clinics Benefit Older Adults 2023

Visits to pain clinics specifically designed for older adults were associated with improvements in pain and pain interference, based on data from 67 pain service centers for older adults in Australia and New Zealand.¹

The PCOP locations included in the study featured easy access by public transportation or close parking, and patients were encouraged to attend with a support person (ie, relative, friend, or other caregiver). Costs were covered by Australia’s universal health insurance. The original PCOP was established in 2012 at St. Vincent’s Hospital in Melbourne.

International Study Examines Older Adult Pain Clinic Outcomes

Chen et al conducted an audit of outcomes among the PCOP chain of facilities in Australia and New Zealand. The study included 203 attendees at 67 clinic locations between 2015 and 2019. The mean age of the participants was 80.5 years, with 77% older than 75 years, and 97% were older than 65 years; 84% met criteria for frailty and 30% met criteria for some degree of cognitive impairment.¹

Clinically meaningful improvement was based on the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) consensus criteria of an improvement of ≥30% in average pain and a 1-point improvement in pain interference based on BPI. The outcomes after attendance at a PCOP were compared to a national benchmark of combined results from other pain services in Australia and New Zealand (the electronic Persistent Pain Outcomes Collaboration (ePPOC).

Findings Demonstrate Meaningful Improvements in Pain

A total of 104 attendees had baseline BPI average pain scores of 5 or higher. In this subgroup, 63% of patients aged 65 to 74 years and 46% of those aged 75 years and older achieved clinically meaningful improvements in BPI average pain scores after attending a PCOP, compared to the national benchmark of 40% for both age groups. A total of 127 attendees had baseline pain interference scores of 5 or higher. In this group, 69% of patients aged 65 to 74 years and 66% of those aged 75 and older achieved clinically meaningful improvements, compared to national benchmarks of 71% and 65% for these age groups.¹

However, the results suggest that older age, cognitive impairment, frailty, and comorbidities were not barriers to older adults achieving meaningful improvements in pain through visits to PCOPs, and highlight the need for more specialized pain services to support the aging population, they concluded.

Discussion

“Compared with the existing literature, this study is unique in describing a population with advanced age and a severe degree of multimorbidity, cognitive impairment, and frailty,” the researchers wrote in their discussion.¹

However, the effectiveness of multidisciplinary pain clinics for older adults remains unclear, and the current study “helps identify the unique challenges of working with older adults, such as frailty, cognitive impairment, and comorbidities, as well as outcomes of a multidisciplinary pain clinic for older adults,” she explained.

Age-Based Approach to Pain Management Needed in the US

Dr. Meints noted she was not surprised by the study findings. “There has been a shift in medicine, including pain medicine, for individualized treatment and care,” she said. “This study builds on that premise by demonstrating that a tailored approach to multidisciplinary pain care is helpful for older adults,” which reflects findings seen in younger populations.

Although the clinics in the study were in New Zealand and Australia, some of the principles used in the pain clinics for older adults might apply to older pain patients in the United States; however, the US has relatively few geriatric clinics or practices, let alone specialty clinics such as the PCOP, said Dr. Meints.

As for additional research, “Next steps should include examining differences in outcomes across pain conditions and identifying predictors of those who respond well to multidisciplinary pain treatment tailored for older adults,” Dr. Meints said.